History of Self-Neglect

Ancient Greece

Diogenes is probably the first recorded case of self-neglect

In the 4th century BCE, Diogenes of Sinope was a Greek Cynic philosopher. He is best known for holding a lantern to the faces of the citizens of Athens, claiming he was searching for an honest man (Mark, 2014). When Alexander the Great asked if there was anything he could do for Diogenes, he replied “could you stand a little out of my sun” (Mark, 2014). Diogenes’ behavior was strongly influenced by his belief that if an act is not shameful in private then it should not be shameful in public. According to him, manners and etiquette should not be observed. He rejected social norms (Pavlou & Lachs, 2008). Diogenes’ ideals were “life according to nature,” “self-sufficiency,” “freedom from emotion,” “lack of shame,” “outspokenness,” and “contempt for social organization” (Cipriani, Lucetti, Vedovello, & Nuti, 2012). Diogenes is an example of intentional self-neglect because of an extreme philosophical belief.

Modern

An APS caseworker using a self-neglect survey in the field

“Senile Breakdown” was the term initially used to describe what is currently known as self-neglect (Macmillan & Shaw, 1966). The condition described 50 years ago is still accurate today: “She, her garments, her possessions, and her house are filthy. She may be verminous and there may be feces and pools of urine on the floor” (Macmillan & Shaw, 1966, p. 1032). Over the following years, the terminology became confusing, with the condition variously being called:

Despite these terminologies, health care providers have been aware since at least 1966 that most, but not all, who suffer from self-neglect are elderly. In 1966, it was believed that there was a strong association with senile psychosis, present in 23 of the 38 cases studied (Macmillan & Shaw, 1966). However, by 1977, it was shown that half had no evidence of a psychiatric disorder and instead possessed higher than average intelligence (Clark et al., 1975). By 1977, it also became clear that the condition was commonly seen among individuals with adequate financial resources; poverty is not a characteristic of self-neglect (Clark et al., 1975).

Did You Know!

Diogenes is an example of intentional self-neglect. He was of sound mind and made a decision to live in that manner

There is still not a complete understanding of self-neglect after more than 50 years of study, It remains unclear whether self-neglect is a distinct syndrome or represents a collection of mental illnesses that have overlapping signs and symptoms (Esposito, Corruble, & Hardy, 2006; Halliday, Banerjee, Philpot, & Macdonald, 2000). Previously, each case of possible SN had to be assessed by a doctor (Clark et. al., 1975). Beginning in the mid-2000’s, screening tools for self-neglect starting to be developed (Naik, Pickens, Burnett, Lai, & Dyer, 2007). Today, self-neglect screening tools are actively used in the field by health care providers (Torbay Safeguarding Adults, 2016). Validation of these screening tools is ongoing (Day, Leahy-Warren, & McCarthy, 2016; Day & McCarthy, 2016).